Comparison Between Oblique Pulling Spinal Manipulation and Other Treatments for Lumbar Disc Herniation: A Systematic Review and Meta-Analysis

J Manipulative Physiol Ther. 2018 Nov-Dec;41(9):771-779. doi: 10.1016/j.jmpt.2018.04.005.


Objective: The purpose of this review was to compare oblique pulling spinal manipulation with other treatments for lumbar disc herniation.

Methods: Randomized controlled trials of oblique pulling manipulation versus other treatment for lumbar disc herniation were identified using the following databases: China National Knowledge Infrastructure, Wanfang Data, Chinese Science and Technology Periodical Database, PubMed, the Cochrane Library, Embase, Chinese Biological Medicine, and Web of Science. Data extraction was carried out based on inclusion and exclusion criteria, and meta-analysis were performed using RevMan 5.3 software.

Results: Nine relevant randomized controlled trials with a total of 887 patients were included. Meta-analysis revealed that oblique pulling manipulation was superior in effective rate to lumbar traction (risk ratio = 1.12; 95% confidence interval [CI]: 1.06-1.19; P < .01) and acupuncture (risk ratio = 1.22; 95% CI: 1.06-1.39; P < .01) and more effective in Visual Analog Scale score (mean difference = - 1.03, 95% CI: -1.32 to -0.74; P < .01) when compared to lumbar traction. It also demonstrated a favorable effect of modified oblique pulling manipulation in Japanese Orthopedic Association scores when compared with lumbar traction (mean difference = 1.66, 95% CI: 0.89 to 2.43; P < .01).

Conclusion: In the treatment of lumbar disc herniation, oblique pulling spinal manipulation presented with a higher effective rate than acupuncture and lumbar traction. Manipulation had a favorable effect in alleviating pain, and modified oblique pulling manipulation had significant superiority in improving lumbar function when compared with lumbar traction. However, considering the low methodological quality of included studies, more rigorously designed trials should be performed in the future.

Keywords: Intervertebral Disc Displacement; Massage; Musculoskeletal Manipulations.

Publication types

  • Meta-Analysis
  • Research Support, Non-U.S. Gov't
  • Systematic Review

MeSH terms

  • Conservative Treatment / methods*
  • Humans
  • Intervertebral Disc Degeneration / therapy*
  • Intervertebral Disc Displacement / therapy*
  • Lumbosacral Region / physiopathology
  • Manipulation, Spinal
  • Musculoskeletal Manipulations / methods*
  • Randomized Controlled Trials as Topic
  • Risk Assessment

Supplementary concepts

  • Intervertebral disc disease